With the number of medical students graduating each year largely static, limited growth in residents and fellows (Box), and a decrease in the numbers of international medical graduates both entering and remaining in the US, demand for other health care providers is likely to increase.32 Compound this with an expanding (and ageing) population, declining physician work effort, and a projected decrease in career spans of doctors, nurses and other health professionals, and the problem appears even greater. Newer workforce theories predict that economic expansion correlates with demand for physician services, which places additional pressure on the existing health system, which will only mount as physician supply fails to keep pace.33

6. Wing P, Langelier MH, Continelli TA, et al. The changing scope of practice of PAs, NPs and CNMs in the United States: 1992 to 2000 [unpublished report]. Rensselaer, NY: Center for Health Workforce Studies, School of Public Health, University of Albany, 2003.